The evaluation of α-tocopherol concentration instead of α-tocopherol:cholesterol ratio in adult cystic fibrosis patients results in the overestimation of vitamin E deficiency
AbstractIntroduction. It has been suggested that serum vitamin E concentrations in CF patients may not properly reflect the body resources of vitamin E. Therefore, we aimed to assess vitamin E status in CF adults relating it to reference values for healthy subjects, also taking into account the α-tocopherol:cholesterol ratio. Material and Methods. The study group was composed of 33 CF patients - 18 (54.5%) females and 15 (45.5%) males - aged from 18 to 47 years. In all CF patients nutritional status and clinical expression of disease - lung function; Pseudomonas aeruginosa colonization; diabetes; cirrhosis; exocrine pancreatic function and vitamin E supplementation were analyzed. Vitamin E (α-tocopherol) concentration was assessed by high-performance liquid chromatography (HPLC). Results. CF adults have lower vitamin E concentrations (median: 830 µg/dl vs. 1132 µg/dl, p=0.00174) and higher vitamin E: cholesterol ratio (median: 7.2 mg/g vs. 6.7 mg/g, p<0.00001) than healthy subjects. The underlying factor that determines this phenomenon is related to low cholesterol levels observed in CF patients. The percentage of low vitamin E concentrations defined in comparison to healthy Polish peers is considerably higher than low vitamin E:cholesterol ratios (39.4% vs. 21.2%, p=0.0011). Conclusions. The evaluation of α-tocopherol concentration instead of ?-tocopherol:cholesterol ratio in CF adults results in the overestimation of vitamin E deficiency. Moreover, there is also potentially a large percentage of individuals with excessive vitamin E body resources. However, this aspect demands further studies.
Sokol RJ. Selection bias and vitamin E and cystic fibrosis. J Pediatr 2007 May;150(5): e85–e86.
Turck D, Braegger CP, Colombo C, Declercq D, Morton A, Pancheva R, et al. ESPEN-ESPGHAN-ECFS guidelines on nutrition care for infants, children, and adults with cystic fibrosis. Clin Nutr. 2016 Jun;35(3):557–577.
Prószyńska K, Bibik K, Książyk J, Lorenc RS, Socha J. Ocena niedoboru witamin A, E, D u dzieci z chorobami wątroby. Pediatria Polska 1991; LXVI,9-10:19–25.
Huang SH, Schall JI, Zemel BS, Stallings VA. Vitamin E status in children with cystic fibrosis and pancreatic insufficiency. J Pediatr. 2006 Apr;148(4):556–559.
Ford L, Farr J, Morris P, Berg J. The value of measuring serum cholesterol-adjusted vitamin E in routine practice. Ann Clin Biochem. 2006 Mar;43(Pt 2):130–134.
Rana M, Wong-See D, Katz T, Gaskin K, Whitehead B, Jaffe A, et al. Fat-soluble vitamin deficiency in children and adolescents with cystic fibrosis. J Clin Pathol. 2014 Jul;67(7):605–608.
Castellani C, Southern KW, Brownlee K, Dankert Roelse J, Duff A, Farrell M, et al. European best practice guidelines for cystic fibrosis neonatal screening. J Cyst Fibros. 2009 May;8(3):153–173.
Farrell PM, White TB, Ren CL, Hempstead SE, Accurso F, Derichs N, et al. Diagnosis of Cystic Fibrosis: Consensus Guidelines from the Cystic Fibrosis Foundation. J Pediatr. 2017 Feb;181S:S4–S15.
Debray D, Kelly D, Houwen R, Strandvik B, Colombo C. Best practice guidance for the diagnosis and management of cystic fibrosis-associated liver disease. J Cyst Fibros. 2011 Jun;10(Suppl 2):S29–S36.
Walkowiak J. Faecal elastase-1: clinical value in the assessment of exocrine pancreatic function in children. Eur J Pediatr. 2000 Nov;159(11):869–870.
Walkowiak J, Nousia-Arvanitakis S, Cade A, Kashirskaya N, Piotrowski R, Strzykala K, et al. Fecal elastase-1 cut-off levels in the assessment of exocrine pancreatic function in cystic fibrosis. J Cyst Fibros. 2002 Dec;1(4):260–264.
Morton A. Why bother to take vitamins? J R Soc Med. 2011 Jul;104(Suppl 1):S19–S29.
Maqbool A, Stallings VA. Update on fat-soluble vitamins in cystic fibrosis. Curr Opin Pulm Med 2008 Nov;14(6):574–581.
Sokol RJ, Heubi JE, Iannaccone ST, Bove KE, Balistreri WF. Vitamin E deficiency with normal serum vitamin E concentrations in children with chronic cholestasis. N Engl J Med. 1984 May;310(19):1209–1212.